The U.S. Agency for International Development (USAID) provided inaccurate location data for at least 22 hospitals in the Afghanistan province of Kabul, placing the health facilities at risk of suffering the same deadly fate as the Doctors Without Borders medical center, according to a watchdog agency appointed by Congress.
John Sopko, the Special Inspector General for Afghanistan Reconstruction (SIGAR), conducted site inspections from July through November 2015 to verify the locations and operating conditions at 32 USAID-funded public hospitals in Kabul province.
The 32 health facilities were subsidized by an estimated $260 million program that provided funding for nearly 600 hospitals in 13 Afghan provinces, including 42 in Kabul province, 10 of which SIGAR was unable to inspect due to security conditions.
In a Jan. 5 letter addressed to Gayle E. Smith, the USAID administrator, SIGAR highlighted the results of its inspections, the second in a series of health facility assessments the inspector general is conducting in provinces throughout Afghanistan.
Besides the “substantial inaccuracies in the geospatial coordinates [in the form of global positioning system (GPS) coordinates]” for most of the inspected health facilities, SIGAR found that “at least 16 facilities disposed of medical waste in open-air kilns, some of which were publicly accessible.”
“This method of unsecured disposal does not adhere to best practices and raises the risk that patients seeking treatment—or children we observed playing outside at several facilities—could be accidentally exposed to contaminated waste,” noted the inspector general.
SIGAR also discovered that not all the American taxpayer-funded health facilities in Kabul province had access to electricity and running water.
Several facilities “suffered from poor maintenance and basic operational challenges—such as a lack of reliable power or water,” wrote Sopko. “For example, we found that five facilities did not have running water, three appeared not to have electricity, and eight may not have adequate or consistent power required for proper lighting and to refrigerate some pharmaceuticals and vaccines.”
The USAID program provided funding “to implementing partners for basic utilities, including electricity, to provide an adequate storage environment for core stocks of pharmaceuticals,” added Sopko. “The absence or inconsistency of electricity to refrigerate these basic stocks raises questions about whether the USAID funding is indeed reaching these facilities.”
Furthermore, SIGAR reported that USAID was unable to demonstrate the physical location or existence of 9 of the 10 health facilities SIGAR was unable to inspect due to security conditions.
Although SIGAR was able to confirm the existence of the other 32 facilities, “site inspections revealed that the actual geospatial coordinates for 7 of the 32 facilities were more than 5 kilometers [about 3 miles] away from the coordinates provided by USAID and the MoPH [Afghan Ministry of Public Health],” revealed the report.
Of the 32 facilities, 22 were less than 0.6 miles from the GPS coordinates provided by USAID; three were 0.6-3 miles away; one was 3-6 miles away; and six were more than 6 miles from the USAID coordinates.
“The recent destruction of the Doctors Without Borders hospital in a battle with the Taliban in Kunduz dramatizes the importance of having accurate GPS coordinates for healthcare facilities,” wrote Sopko in an Oct. 20 letter to USAID, referring to the accidental U.S. military bombing of a health center in Afghanistan that killed at least 30 doctors and patients on Oct. 3.
At the time, SIGAR found “substantial inaccuracies” in the GPS coordinates USAID provided for 23 of the 63 healthcare facilities it maintains in Afghanistan’s Herat province.
In response to SIGAR’s most recent letters, USAID reportedly said it is working with Afghanistan’s Ministry of Public Health to obtain more accurate GPS coordinates for the hospitals it supports.
However, USAID, in response to the inspector general’s June 2015 letter, wrote that “the lack of precise geospatial data in most cases does not interfere with our ability to effectively monitor” the program it uses to fund the health facilities.
“We believe that accurate location-specific information, including geospatial coordinates, is critical to effective oversight,” wrote Sopko in the recent Jan. 5 letter.
Sopko noted that since 2014 his office has expressed concern regarding the oversight of facilities supported by the USAID program that provides funding for the health facilities across Afghanistan.